Mellisha Ruiz
Kenner ,LA
Summary
Professional with deep knowledge and experience in investigating benefits claims, adept at uncovering discrepancies and ensuring compliance. Skilled in data analysis, problem-solving, and research, with strong emphasis on accuracy and integrity. Known for fostering team collaboration and adapting to evolving needs, consistently delivering reliable and impactful results.
Overview
12
12
years of professional experience
Work History
Benefits Investigator
BioPlus Specialty Pharmacy
Harvey, LA
07.2022 - Current
- Reduced errors in benefits investigations by conducting thorough reviews and maintaining up-to-date knowledge on regulations.
- Identified insurance coverage limitations with thorough examinations of claims documentation and related records.
- Read over insurance policies to ascertain levels of coverage and determine whether claims would receive approvals or denials.
Customer Service Representative
CVS Caremark
08.2020 - 06.2022
- Responded to incoming calls from members, providing information about their pharmacy benefits
- Delivered support and empathy with a positive attitude, aiming to simplify members’ healthcare experience
Sr Order Entry Technician
Omnicare
River Ridge, LA
08.2013 - 03.2020
- Completed accurate order entry and data verification.
- Increased order accuracy by meticulously reviewing and entering customer orders into the system.
- Enhanced team productivity by cross-training on various roles within the department and assisting colleagues during peak periods.
Education
Health Administration
University of Phoenix
Remote04.2012
Skills
- Benefits administration
- HIPAA compliance
- Claims processing
- Insurance policy knowledge
- Claims investigation
- Computer skills
Timeline
Benefits Investigator
BioPlus Specialty Pharmacy
07.2022 - Current
Customer Service Representative
CVS Caremark
08.2020 - 06.2022
Sr Order Entry Technician
Omnicare
08.2013 - 03.2020
Health Administration
University of Phoenix